817-653-8976 info@project4031.org

Fulfilling Dreams Application

Hospice Referral

Project 4031 grants last Dreams for terminally ill children and adults with a current life expectancy of six months or less. We are a small nonprofit located in Fort Worth, TX and primarily serve patients living in Texas, with a concentration in the DFW area. We do our very best and make every effort to make Dreams come true for those unable to fulfill them on their own.

Fulfilling Dreams Application

This application is ONLY for hospice representatives to submit. ONLY Hospice Social Workers, Child Life Specialists, Nurses, or Physicians can submit this application.

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Who is eligible to apply?
Terminally ill children and adults with a life expectancy of six months or less are eligible for a last Dream. Before applying please ensure that your patient’s Dream request is a viable option given their current health conditions. Patients should think of various options and have an alternate Dream request in mind that is entirely unrelated to the first Dream. We grant last Dreams, so it is not relevant if they have received a Dream/Wish in the past from another organization. Although we request this information be provided, it will not affect their application.

Application Instructions: *IMPORTANT* No pictures of applications will be accepted.
Completed applications can be faxed to (817) 841-8250, scanned and emailed to info@project4031.org, mailed or delivered in person to 708 May St, Fort Worth, TX 76104. We receive many requests and review each one as quickly as possible, with a goal to contact you within two business days of receiving the completed application. We know time is of the essence, so please help us make Dreams come true by submitting all required information in a timely manner. Please read through the application carefully and fill it out in its entirety before submitting. If you are not sure if your application is complete, please call us at (817) 653-8976. If we receive an incomplete application, it will not be processed until all required information is received. Depending on the Dream request, Project 4031 may require additional information.

We cannot fulfill the following types of Dreams:

  • Medical treatments/medical bills/prescription medications
  • Posthumous requests from family members (travel arrangements to attend funeral)
  • Property and home improvements
  • Automobiles and lifts
  • Reimbursements for completed Dreams
  • Cash
  • Legal assistance
  • Inground pools
  • Trips involving gambling
  • Firearms
  • Any Dream request deemed inappropriate or inconsistent with Project 4031 values

Project 4031 must have the following documents to process your Dream request:

  • Copy of the Patient’s Hospice Face Sheet
  • Signed Medical/Media Release
  • Signed HIPAA Form
  • Signed Waiver and Release of Liability Form
  • Copy of the adult participant’s (primary driver) driver’s license and car insurance for travel request

Partnerships

Contact Us

708 May Street, Fort Worth, Texas, 76104
info[at]project4031.org
Phone: (817) 653-8976
Fax: (817) 841-8250